Oral health needs among adults in the United States with chronic diseases
Griffin SO , Barker LK , Griffin PM , Cleveland JL , Kohn W . J Am Dent Assoc 2009 140 (10) 1266-74 BACKGROUND: Oral and dental diseases may be associated with other chronic diseases. METHODS: Using data from the National Health and Nutrition Examination Survey 1999-2004, the authors calculated the prevalence of untreated dental diseases, self-reported poor oral health and the number of missing teeth for adults in the United States who had certain chronic diseases. The authors used multivariate analysis to determine whether these diseases were associated with indicators of dental disease after controlling for common risk factors. RESULTS: Participants with rheumatoid arthritis, diabetes or a liver condition were twice as likely to have an urgent need for dental treatment as were participants who did not have these diseases. After controlling for common risk factors, the authors found that arthritis, cardiovascular disease, diabetes, emphysema, hepatitis C virus, obesity and stroke still were associated with dental disease. CONCLUSIONS: The authors found a high burden of unmet dental care needs among participants with chronic diseases. This association held in the multivariate analysis, suggesting that some chronic diseases may increase the risk of developing dental disease, decrease utilization of dental care or both. CLINICAL IMPLICATIONS: Dental and medical care providers should work together to ensure that adults with chronic diseases receive regular dental care. |
Racial differences in self-reported pain and function among individuals with radiographic hip and knee osteoarthritis: the Johnston County Osteoarthritis Project
Allen KD , Helmick CG , Schwartz TA , DeVellis RF , Renner JB , Jordan JM . Osteoarthritis Cartilage 2009 17 (9) 1132-6 OBJECTIVE: This study compared pain and function among African Americans and Caucasian with radiographic hip and/or knee osteoarthritis (OA), controlling for radiographic severity and other patient characteristics. METHODS: Participants were 1368 individuals (32% African American) from the Johnston County Osteoarthritis Project with only knee OA, only hip OA, and both knee and hip OA. Linear regression models examined racial differences in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores and pain and function subscales, adjusting for radiographic severity, age, gender, education, body mass index (BMI), depressive symptoms, and WOMAC pain (last variable in models of function). RESULTS: Among those with only knee OA, African Americans had significantly worse mean WOMAC total scores than Caucasian (32.8 vs 24.3, P<0.001), and worse pain and function scores (P<0.001). Racial differences in WOMAC total, pain, and function scores persisted when controlling for radiographic severity and demographic factors but were not significant when also controlling for BMI and depressive symptoms. In models of WOMAC function, pain was the most strongly associated variable and substantially reduced the association of race with function. There were no racial differences in WOMAC scores among those with only hip OA or with both knee and hip OA. CONCLUSION: Among participants with knee OA, racial differences in pain and function may be explained by BMI and depressive symptoms, and racial differences in function may also be largely influenced by pain. Improving management of weight and depressive symptoms may be key steps toward reducing racial disparities in knee OA symptoms. |
Burden of cardiovascular disease in Asia: big challenges and ample opportunities for action and making a difference
Hong Y . Clin Chem 2009 55 (8) 1450-2 Cardiovascular disease (CVD)1 is the leading cause of death in the world, accounting for 30% of deaths globally. The major cardiovascular diseases include coronary or ischemic heart disease, cerebrovascular disease or stroke, hypertension, heart failure, and rheumatic heart disease. Although the CVD mortality rate has declined in the US and the rest of the developed world, the rate has increased in the developing world, including most Asian countries. The estimated number of deaths due to CVD worldwide was 17.5 million in 2005 and will increase to 20 million in 2015. Further, Asian countries have disproportionately high morbidity and mortality from stroke compared with Western countries. These unique patterns of CVD deserve more attention, because half of the world’s population lives in Asia. | The December themed issue of Circulation highlighted reviews and original studies on risk factors, prevalence, awareness, treatment, control, mortality, and secular trends of CVD in Asia with a specific focus on China, India, Japan, and Korea. As pointed out in the editorial comment in that issue of Circulation, the relationship between traditional risk factors and CVD is different in Asia than in Western societies, and there are some unique features about risk factors and metabolic abnormalities for CVD in Asia (1). For example, hypertension plays a more important role in the development of heart disease and stroke in Asia than in Western countries. The prevalence of obesity and overweight in Asia has been increasing as a consequence of economic development in the past two to three decades. The rate of increase for diabetes has been even more substantial. Mean cholesterol levels are lower for adults in most Asian countries than in Western countries, but an increasing trend has been observed. Genetic predisposition and the interaction between genetic and environmental factors also contribute to the difference in CVD between Asians and people living on other continents. |
Pandemic influenza planning: addressing the needs of children
Stevenson E , Barrios L , Cordell R , Delozier D , Gorman S , Koenig LJ , Odom E , Polder J , Randolph J , Shimabukuro T , Singleton C . Am J Public Health 2009 99 S255-60 Children represent one quarter of the US population. Because of its enormous size and special needs, it is critically important to address this population group in pandemic influenza planning. Here we describe the ways in which children are vulnerable in a pandemic, provide an overview of existing plans, summarize the resources available, and, given our experience with influenza A(H1N1), outline the evolving lessons we have learned with respect to planning for a severe influenza pandemic. We focus on a number of issues affecting children-vaccinations, medication availability, hospital capacity, and mental health concerns-and emphasize strategies that will protect children from exposure to the influenza virus, including infection control practices and activities in schools and child care programs. |
Pandemic influenza preparedness and response among public-housing residents, single-parent families, and low-income populations
Bouye K , Truman BI , Hutchins S , Richard R , Brown C , Guillory JA , Rashid J . Am J Public Health 2009 99 S287-93 During the early stages of an influenza pandemic, a pandemic vaccine likely will not be available. Therefore, interventions to mitigate pandemic influenza transmission in communities will be an important component of the response to a pandemic. Public-housing residents, single-parent families, and low-income populations may have difficulty complying with community-wide interventions. To enable compliance with community interventions, stakeholders recommended the following: (1) community mobilization and partnerships, (2) culturally specific emergency communications planning, (3) culturally specific education and training programs, (4) evidence-based measurement and evaluation efforts, (5) strategic planning policies, (6) inclusion of community members as partners, and (7) policy and program changes to minimize morbidity and mortality. |
Pandemic influenza: implications for programs controlling for HIV infection, tuberculosis, and chronic viral hepatitis
Heffelfinger JD , Patel P , Brooks JT , Calvet H , Daley CL , Dean HD , Edlin BR , Gensheimer KF , Jereb J , Kent CK , Lennox JL , Louie JK , Lynfield R , Peters PJ , Pinckney L , Spradling P , Voetsch AC , Fiore A . Am J Public Health 2009 99 S333-9 Among vulnerable populations during an influenza pandemic are persons with or at risk for HIV infection, tuberculosis, or chronic viral hepatitis. HIV-infected persons have higher rates of hospitalization, prolonged illness, and increased mortality from influenza compared with the general population. Persons with tuberculosis and chronic viral hepatitis may also be at increased risk of morbidity and mortality from influenza because of altered immunity and chronic illness. These populations also face social and structural barriers that will be exacerbated by a pandemic. Existing infrastructure should be expanded and pandemic planning should include preparations to reduce the risks for these populations. |
Preparing for and responding to pandemic influenza: implications for people with disabilities
Campbell VA , Gilyard JA , Sinclair L , Sternberg T , Kailes JI . Am J Public Health 2009 99 S294-300 State, local, tribal, and territorial emergency managers and public health officials must address the specific needs of people with disabilities in their pandemic influenza plans. Evidence from Hurricane Katrina indicated that this population was disproportionately affected by the storm and aftermath. People with disabilities, particularly those who require personal assistance and those who reside in congregate care facilities, may be at increased risk during an influenza pandemic because of disrupted care or the introduction of the virus by their caregivers. Emergency and public health planners must ensure that personal assistance agencies and congregate care operators make provisions for backup staffing and that those who provide critical care are given adequate antiviral drugs and vaccines as they become available. |
A primer on strategies for prevention and control of seasonal and pandemic influenza
Santibanez S , Fiore AE , Merlin TL , Redd S . Am J Public Health 2009 99 S216-24 The United States has made considerable progress in pandemic preparedness. Limited attention, however, has been given to the challenges faced by populations that will be at increased risk of the consequences of the pandemic, including challenges caused by societal, economic, and health-related factors. This supplement to the American Journal of Public Health focuses on the challenges faced by at-risk and vulnerable populations in preparing for and responding to an influenza pandemic. Here, we provide background information for subsequent articles throughout the supplement. We summarize (1) seasonal influenza epidemiology, transmission, clinical illness, diagnosis, vaccines, and antiviral medications; (2) H5N1 avian influenza; and (3) pandemic influenza vaccines, antiviral medications, and nonpharmaceutical interventions. |
Protecting vulnerable populations from pandemic influenza in the United States: a strategic imperative
Hutchins SS , Truman BI , Merlin TL , Redd SC . Am J Public Health 2009 99 S243-8 Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations. |
Protection of racial/ethnic minority populations during an influenza pandemic
Hutchins SS , Fiscella K , Levine RS , Ompad DC , McDonald M . Am J Public Health 2009 99 S261-70 Racial/ethnic minority populations experience worse health outcomes than do other groups during and after disasters. Evidence for a differential impact from pandemic influenza includes both higher rates of underlying health conditions in minority populations, increasing their risk of influenza-related complications, and larger socioeconomic (e.g., access to health care), cultural, educational, and linguistic barriers to adoption of pandemic interventions. Implementation of pandemic interventions could be optimized by (1) culturally competent preparedness and response that address specific needs of racial/ethnic minority populations, (2) improvements in public health and community health safety net systems, (3) social policies that minimize economic burdens and improve compliance with isolation and quarantine, and (4) relevant, practical, and culturally and linguistically tailored communications. |
Respiratory protection against influenza
Srinivasan A , Perl TM . JAMA 2009 302 (17) 1903-4 The 2009 influenza A(H1N1) pandemic has revived | debate about the role of respiratory protection | in preventing the transmission of influenza to health | care personnel (HCP). The Centers for Disease Control | and Prevention (CDC) guidelines for preventing transmission | of seasonal influenza are intended to limit exposure | to large respiratory droplets and recommend the use of a medical | (surgical) mask during the care of a patient with influenza | as part of a comprehensive infection control strategy.*'^ | However, data suggest that under certain conditions, influenza | viruses can be transmitted via smaller particles that evade | filtration by such masks.^ Unlike medical masks, N95 particulate | respirators protect wearers from small particles when | appropriately designed and worn.’* Recommendations to prevent | influenza transmission take on special importance during | pandemics, when there is little, if any, native immunity | and vaccine is not available immediately.'' |
A review of the Centers for Disease Control and Prevention's response to the HIV/AIDS crisis among blacks in the United States, 1981-2009
Sutton MY , Jones RL , Wolitski RJ , Cleveland JC , Dean HD , Fenton KA . Am J Public Health 2009 99 S351-9 Among US racial/ethnic groups, Blacks are at the highest risk of acquiring HIV/AIDS. In response, the Centers for Disease Control and Prevention (CDC) has launched the Heightened National Response to Address the HIV/AIDS Crisis Among African Americans, which seeks to engage public and nonpublic partners in a synergistic effort to prevent HIV among Blacks. The CDC also recently launched Act Against AIDS, a campaign to refocus attention on the domestic HIV/AIDS crisis. Although the CDC's efforts to combat HIV/AIDS among Blacks have achieved some success, more must be done to address this crisis. New initiatives include President Obama's goal of developing a National HIV/AIDS Strategy to reduce HIV incidence, decrease HIV-related health disparities, and increase access to care, especially among Blacks and other disproportionately affected populations. |
Screening for HSV-2 infection in STD clinics and beyond: a few answers but more questions
Douglas JM Jr , Berman SM . Sex Transm Dis 2009 36 (11) 729-31 Genital herpes simplex virus [HSV]-2 is considered the highest prevalence sexually transmitted infection in the United States, with an estimated 17% of all adolescents and adults infected.1 Although asymptomatic in most persons, HSV-2 causes a range of important problems, including recurrent genital ulcerations, devastating neonatal infection, and enhanced HIV transmission, with estimates that HSV-2 may account for 25% to 35% of HIV infections in sub-Saharan Africa.2 Conventional tools for prevention and control (e.g., curative therapy, vaccines) do not exist for HSV-2. However, strategies that do exist—serologic tests for diagnosis, disclosure to partners, the use of condoms,3,4 and antiviral therapy that suppresses symptoms and reduces transmission5—are analogous to those in use for HIV prevention, and, over the past decade, the magnitude of the population burden associated with HSV-2 has stimulated discussion about the value of initiating broad prevention programs.6–10 | The appropriate use and likely effect of these approaches, particularly the role of widespread serologic testing, has generated controversy. Since over 80% of infected persons are unaware of their diagnosis1 and most transmission is from individuals with unrecognized infection,11 identifying those who are infected is a logical starting point for prevention. Type-specific serologic tests for herpes, available over the past decade, represent a major improvement over the earlier, nonspecific, whole antigen tests.12 However, based on concerns over test performance in low-prevalence populations and lack of data about benefit of testing, screening has not been recommended in general populations, although there continues to be debate about its role in targeted populations such as those attending sexually transmitted disease [STD] clinics. |
Two tuberculosis genotyping clusters, one preventable outbreak
Buff AM , Sosa LE , Hoopes AJ , Buxton-Morris D , Condren TB , Hadler JL , Haddad MB , Moonan PK , Lobato MN . Public Health Rep 2009 124 (4) 490-4 In 2006, eight community tuberculosis (TB) cases and a ninth incarceration-related case were identified during an outbreak investigation, which included genotyping of all Mycobacterium tuberculosis isolates. In 1996, the source patient had pulmonary TB but completed only two weeks of treatment. From February 2005 to May 2006, the source patient lived in four different locations while contagious. The outbreak cases had matching isolate spoligotypes; however, the mycobacterial interspersed repetitive unit (MIRU) patterns from isolates from two secondary cases differed by one tandem repeat at a single MIRU locus. The source patient's isolates showed a mixed mycobacterial population with both MIRU patterns. Traditional and molecular epidemiologic methods linked eight secondary TB cases to a single source patient whose incomplete initial treatment, incarceration, delayed diagnosis, and housing instability resulted in extensive transmission. Adequate treatment of the source patient's initial TB or early diagnosis of recurrent TB could have prevented this outbreak. |
CDC and FDA response to risk of confusion in dosing Tamiflu oral suspension
Budnitz DS , Lewis LL , Shehab N , Birnkrant D . N Engl J Med 2009 361 (19) 1913-4 On September 23, Parker et al.1 described a case in which Tamiflu (oseltamivir) for oral suspension was dispensed with pharmacy instructions to administer the drug in volume units (teaspoons), whereas the manufacturer's dosing syringe accompanying the product is calibrated in milligrams. Interest in the use of oseltamivir for young children has risen since the emergence of 2009 pandemic influenza A (H1N1) virus. We recognize that dosing instructions with units different from those given on the device included with the product create risks of confusion and dosing errors. | Together, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have acted promptly to provide information that emphasizes appropriate dosing and dispensing of Tamiflu for oral suspension. Communications regarding potential dosing errors were posted on the CDC and FDA Web sites, and Roche has published a “Dear Healthcare Professional” letter.2 All communications recommend that, when dispensing commercially manufactured Tamiflu for oral suspension, pharmacists should ensure that the units of measure on the dosing instructions match those on the device provided. If the dosing instructions specify volumetric measures (teaspoons or milliliters), the manufacturer's syringe should be removed and replaced with an appropriate device with matching units. When dispensing this suspension for children younger than 1 year of age, according to the Emergency Use Authorization, the syringe in the package should always be replaced with an appropriate measuring device, because doses for children younger than 1 year of age cannot be measured with the manufacturer's syringe.3 |
Chlamydia prevalence among women and men entering the National Job Training Program: United States, 2003-2007
Satterwhite CL , Tian LH , Braxton J , Weinstock H . Sex Transm Dis 2009 37 (2) 63-7 OBJECTIVE: To analyze 5-year prevalence trends in Chlamydia trachomatis infections among high-risk young men and women aged 16 to 24 years entering the National Job Training Program, where universal screening is required. METHODS: Entrance exams conducted in over 100 National Job Training Program centers from 2003 to 2007 were considered. Women provided cervical specimens tested using either a DNA hybridization probe (PACE 2, Gen-Probe, San Diego, CA) or a strand displacement amplification test (SDA, BD ProbeTec ET, Becton-Dickinson, Sparks, MD). In the absence of a pelvic exam, urine specimens were tested using SDA. PACE 2 testing was performed predominately from 2002 to 2005; from 2005 to 2007, SDA was used. All male testing was conducted using SDA on urine specimens. Chlamydia prevalence trends were assessed for women and men, using logistic regression models. Adjusted odds ratios (AOR), 95% confidence intervals (CI), and P-values were calculated. RESULTS: Approximately 15,000 women and 30,000 men were screened annually for chlamydia. Among both sexes, adjusted prevalence declined significantly from 2003 to 2007. In 2003, crude prevalence among women was 9.9%; in 2007, prevalence was 13.7%. However, after controlling for covariates, including increasingly sensitive tests, the model indicated a significant declining prevalence trend (AOR: 0.95, CI: 0.93-0.97, 4.6% decrease in odds per year). Among men, crude prevalence in 2003 was 8.4%; in 2007, prevalence was 8.3%; after controlling for possible confounding, a significant decline in prevalence was also detected (AOR: 0.98, CI: 0.96-0.99, 1.9% decrease in odds per year). CONCLUSIONS: In a relatively stable, high-risk population of young women and men, adjusted chlamydia prevalence declined from 2003 to 2007. Test technology plays a critical role in interpreting rates and should be considered whenever chlamydia rates are examined. |
Cost-effectiveness of routine rapid human immunodeficiency virus antibody testing before DNA-PCR testing for early diagnosis of infants in resource-limited settings
Menzies NA , Homsy J , Pitter JYC , Pitter C , Mermin J , Downing R , Finkbeiner T , Obonyo J , Kekitiinwa A , Tappero J , Blandford JM . Pediatr Infect Dis J 2009 28 (9) 819-825 BACKGROUND: Infants born to HIV-infected women should receive HIV testing to allow early diagnosis and treatment. Recommendations for resource-limited settings stress laboratory-based virologic assays. While effective, these tests are logistically complex and expensive. This study explored the cost-effectiveness of incorporating initial screening with rapid HIV tests (RHT) into the conventional testing algorithm to screen-out HIV-uninfected infants, thereby reducing the need for costly virologic testing. METHODS: Data on HIV prevalence, RHT sensitivity and specificity, and costs were collected from 820 HIV-exposed children (1.5-18 months) attending 2 postnatal screening programs in Uganda during July 2005 to December 2006. Cost-effectiveness models compared the conventional testing algorithm DNA polymerase chain reaction (DNA-PCR with Roche Amplicor v1.5) with a modified algorithm (initial RHT to screen-out HIV-uninfected infants before DNA-PCR). RESULTS: The model estimated that the conventional algorithm would identify 94.3% (91.8%-94.7%) of HIV-infected infants, compared with 87.8% (79.4%-90.5%) for a modified algorithm using RHT (HIV 1/2 Determine) and excluding the need for DNA-PCR for HIV antibody-negative infants. Costs per infant were $23.47 ($23.32-$23.76) for the conventional algorithm and between $22.75 ($21.89-$23.31) and $7.58 ($6.41-$10.75) for the modified algorithm, depending on infant age and symptoms. Compared with the conventional algorithm, costs per HIV-infected infant identified using the modified algorithm were higher in 1.5- to 3-month-old infants, but significantly lower in 3-month-old and older infants. Models replicating the whole infant testing program showed the modified algorithm would have marginally lower sensitivity, but would reduce total program costs by 27% to 40%, producing an incremental cost-effectiveness ratio of $1489 ($686-$6781) for the conventional versus modified algorithms. CONCLUSIONS: Screening infants with RHT before DNA-PCR is cost-effective in infants 3 months old or older. Incorporating RI-IT into early infant testing programs could improve cost-effectiveness and reduce program costs. |
Cryptosporidiosis from a community swimming pool: outbreak investigation and follow-up study
Boehmer TK , Alden NB , Ghosh TS , Vogt RL . Epidemiol Infect 2009 137 (11) 1651-4 Tri-County Health Department investigated an outbreak of cryptosporidiosis linked to a community swimming pool. A cohort study was conducted in 37 persons who were invited to the pool party; 12 (57%) of 21 attendees had primary cryptosporidiosis infection. Risk factors for illness included swimming, getting water in mouth, and swallowing water. The pool met chlorination guidelines and used UV light irradiation, a supplemental disinfection technology that inactivates Cryptosporidium. A follow-up survey of the cohort was completed 7-8 weeks after the pool party; four (25%) of 16 non-attendees had secondary cryptosporidiosis infection. The median duration of illness, including patients with recurring symptoms, was 26 days. Clinical response rate to nitazoxanide, a therapeutic agent, was 67%. This study is unique because it describes a cryptosporidiosis outbreak from a well-maintained community swimming pool using supplemental disinfection. It also reports information on disease burden and treatment response. |
[Detection of mecA gene in oxacillin-resistant coagulase-negative staphylococci isolated from the saliva of nursing professionals]
Rosa Jde O , de Moura JP , Palos MA , Gir E , Reis C , Kipnis A , Canini SR , Belissimo-Rodrigues F , Pimenta FC . Rev Soc Bras Med Trop 2009 42 (4) 398-403 Coagulase-negative staphylococci are frequently associated with nosocomial infections, and healthcare professionals can be reservoirs and spread them in hospitals and in the community. The aim of this study was to identify species of coagulase-negative staphylococci isolated from the saliva of nursing professionals, determine the resistance profile and detect the mecA gene. One hundred coagulase-negative staphylococci were selected: 41 were identified as Staphylococcus epidermidis, 25 as Staphylococcus saprophyticus, 18 as Staphylococcus haemolyticus, eight as Staphylococcus cohnii, four as Staphylococcus lugdunenses, three as Staphylococcus capitis and one as Staphylococcus simulans. Of these, 32% presented oxacillin resistance, 84.4% mupirocin resistance and 32% cefoxitin resistance, and all were vancomycin sensitive. Among the oxacillin-resistant coagulase-negative staphylococci, 93.7% developed in oxacillin agar (6microg/ml) and the mecA gene was detected in 75%. The results indicate that higher investments should be directed towards identifying coagulase-negative staphylococcus species in healthcare institutions and in the community. |
Estimating influenza-associated deaths in the United States
Thompson WW , Moore MR , Weintraub E , Cheng PY , Jin X , Bridges CB , Bresee JS , Shay DK . Am J Public Health 2009 99 S225-30 Most estimates of US deaths associated with influenza circulation have been similar despite the use of different approaches. However, a recently published estimate suggested that previous estimates substantially overestimated deaths associated with influenza, and concluded that substantial numbers of deaths during a future pandemic could be prevented because of improvements in medical care. We reviewed the data sources and methods used to estimate influenza-associated deaths. We suggest that discrepancies between the recent estimate and previous estimates of the number of influenza-associated deaths are attributable primarily to the use of different outcomes and methods. We also believe that secondary bacterial infections will likely result in substantial morbidity and mortality during a future influenza pandemic, despite medical progress. |
Expedited partner therapy for adolescents diagnosed with chlamydia or gonorrhea: a position paper of the Society for Adolescent Medicine
Burstein GR , Eliscu A , Ford K , Hogben M , Chaffee T , Straub D , Shafii T , Huppert J . J Adolesc Health 2009 45 (3) 303-9 Chlamydia and gonorrhea, the most frequently reported sexually transmitted infections (STIs), present substantial public health challenges among adolescents. Although these infections are easily treated with antibiotics, many adolescents are reinfected within 3–6 months, usually because their partners remain untreated. The standard approaches to notifying and treating a partner of an STI-infected patient are patient referral, whereby the patient notifies his/her partners to seek care, and provider referral, whereby the provider or public health disease intervention specialist notifies the partner and directs him/her toward treatment. These methods rely on the accuracy of the disclosed partner information as well as other limitations, such as compliance and staffing resources. Another approach to partner notification is expedited partner therapy (EPT), treating sex partners without requiring a prior clinical evaluation. In randomized trials, EPT has reduced the rates of persistent or recurrent gonorrhea and chlamydia infection; however, its routine use is limited by concerns related to liability, cost, compliance, and missed opportunities for prevention counseling. The Society for Adolescent Medicine (SAM) recommends that providers who care for adolescents should do the following: use EPT as an option for STI care among chlamydia- or gonorrhea-infected heterosexual males and females who are unlikely or unable to otherwise receive treatment; through SAM and AAP chapters, collaborate with policy makers to remove EPT legal barriers and facilitate reimbursement; and collaborate with health departments for implementation assistance. |
HPV 6/11, 16, 18 seroprevalence in men in two US cities
Dunne EF , Nielson CM , Hagensee ME , Papenfuss MR , Harris RB , Herrel N , Gourlie J , Abrahamsen M , Markowitz LE , Giuliano AR . Sex Transm Dis 2009 36 (11) 671-4 BACKGROUND: A vaccine to prevent human papillomavirus (HPV) 6, HPV 11, HPV 16, or HPV 18 and associated diseases is licensed for females, and it may be licensed for men in the future. There are limited data on HPV 6/11, 16, and/or 18 seroprevalence in men. METHODS: A total of 490 men aged 18 to 40 years were enrolled in a study of HPV in men in Tucson, AZ, and Tampa, FL. Enrolled men completed a self-administered questionnaire, and HPV serology was performed using HPV 6/11, 16, and 18 VLP assays. RESULTS: Overall, seroprevalence to HPV 16 was 12.1%, HPV 6/11 was 9.7%, and to HPV 18 was 5.4%. Seroprevalence to HPV 6/11, 16, and/or 18 was 21% and was highest among 35 to 40 year olds (48%); prevalence in this age group was significantly higher compared to the 18 to 24 year olds (adjusted odds ratio (aOR) 6.8, 95% confidence interval (CI) 3.7, 12.8). Independent predictors of seropositivity to HPV 6/11, 16, and/or 18 were older age, greater number of female sex partners in the past 3 months, and current smoking. CONCLUSIONS: HPV vaccine-type seroprevalence was highest in 35 to 40 year old men. These data on the epidemiology of HPV seroprevalence in men are useful for discussions regarding recommendations for HPV vaccine if licensed for use in men. |
Variability of Burkholderia pseudomallei strain sensitivities to chlorine disinfection
O'Connell HA , Rose LJ , Shams A , Bradley M , Arduino MJ , Rice EW . Appl Environ Microbiol 2009 75 (16) 5405-9 Burkholderia pseudomallei is a select agent and the causative agent of melioidosis. Variations in previously reported chlorine and monochloramine concentration time (Ct) values for disinfection of this organism make decisions regarding the appropriate levels of chlorine in water treatment systems difficult. This study identified the variation in Ct values for 2-, 3-, and 4-log(10) reductions of eight environmental and clinical isolates of B. pseudomallei in phosphate-buffered water. The greatest calculated Ct values for a 4-log(10) inactivation were 7.8 mg.min/liter for free available chlorine (FAC) at pH 8 and 5 degrees C and 550 mg.min/liter for monochloramine at pH 8 and 5 degrees C. Ionic strength of test solutions, culture hold times in water, and cell washing were ruled out as sources of the differences in prior observations. Tolerance to FAC was correlated with the relative amount of extracellular material produced by each isolate. Solid-phase cytometry analysis using an esterase-cleaved fluorochrome assay detected a 2-log(10)-higher level of organisms based upon metabolic activity than did culture, which in some cases increased Ct values by fivefold. Despite strain-to-strain variations in Ct values of 17-fold for FAC and 2.5-fold for monochloramine, standard FAC disinfection practices utilized in the United States should disinfect planktonic populations of these B. pseudomallei strains by 4 orders of magnitude in less than 10 min at the tested temperatures and pH levels. |
Dead-end hollow-fiber ultrafiltration for recovery of diverse microbes from water
Smith CM , Hill VR . Appl Environ Microbiol 2009 75 (16) 5284-9 Dead-end ultrafiltration (DEUF) is an alternative approach to tangential-flow hollow-fiber ultrafiltration that can be readily employed under field conditions to recover microbes from water. The hydraulics of DEUF and microbe recovery for a new DEUF method were investigated using 100-liter tap water samples. Pressure, flow rate, and temperature were investigated using four hollow-fiber ultrafilter types. Based on hydraulic performance, the Asahi Kasei REXEED 25S ultrafilter was selected for microbe recovery experiments. Microbe recovery experiments were performed using MS2 bacteriophage, Enterococcus faecalis, Clostridium perfringens spores, and Cryptosporidium parvum oocysts. Microbes were recovered from ultrafilters by backflushing using a surfactant solution. Average flow rates were 2.1 liters/min for 100-liter water samples having turbidities of 0.28 to 4.3 nephelometric turbidity units (NTU), and no evidence of appreciable filter clogging was observed. The DEUF average recovery efficiencies for each study analyte in tap water were as follows: for E. faecalis, 93% +/- 16%; for MS2, 57% +/- 7.7%; for C. perfringens spores, 94% +/- 22%; and for C. parvum, 87% +/- 18%. Average microbe recoveries for tap water amended with surface water (average turbidity = 4.3 NTU) were as follows: for E. faecalis, 78% +/- 12%; for MS2, 73% +/- 13%; for C. perfringens, 57% +/- 21%; and for C. parvum, 83% +/- 21%. These data demonstrate that DEUF is an effective method for recovering diverse microbes from water and should be a useful tool for field-based environmental investigations. |
Novel human leukocyte antigen class I and class II alleles identified by sequence-based typing in the Genetics of Kidneys in Diabetes (GoKinD) study population
Cordovado SK , Hancock LN , Hendrix M , Greene CN , Mueller PW . Hum Immunol 2009 70 (9) 747-9 Nine novel HLA class I and class II alleles were identified by sequence-based typing (SBT) in Caucasian participants from the Genetics of Kidneys in Diabetes (GoKinD) study. All novel alleles were single nucleotide substitutions. Seven alleles resulted in an amino acid change and two alleles were silent substitutions. The new alleles are as follows: five HLA-A alleles (*0132, *020121, *0344, *030107, *2507), one HLA-C allele (*0619), two HLA-DQB1 alleles (*0204, *0318), and one HLA-DPB1 allele (*1802). Eight of these new alleles were identified in participants with type 1 diabetes, three of whom also had diabetic nephropathy, and one new allele was identified in an unaffected parent of a participant with type 1 diabetes. All new alleles were isolated and characterized by use of single allele amplification (SAA) SBT; the new alleles were confirmed by sequence-specific primer (SSP) amplification. |
Influenza vaccination attitudes and practices among US registered nurses
Clark SJ , Cowan AE , Wortley PM . Am J Infect Control 2009 37 (7) 551-6 BACKGROUND: The influenza vaccination rate among US health care personnel (HCP) remains low and may vary by occupational categories. The objective of this study was to explore knowledge, attitudes, and beliefs associated with influenza vaccination in a broad population of registered nurses. METHODS: The study used a cross-sectional mail survey, administered January-March 2006, of 2000 registered nurses in 4 US states. RESULTS: Of the 2000 surveys sent, 1310 (72%) were returned, and 1017 (67%) were eligible for analysis. The majority of respondents (59%) reported receiving influenza vaccine during the 2005-2006 influenza season. The most common reason for being vaccinated was protecting oneself from illness (95%), and the most common reason for not being vaccinated was concern about adverse reactions (39%). Respondents who reported their patient population as high risk related to influenza were more likely to be vaccinated and to agree with statements regarding influenza disease and influenza vaccination of HCP. CONCLUSION: Concerns about adverse reactions and vaccine effectiveness continue to be barriers to influenza vaccination among registered nurses. Those most knowledgeable about influenza vaccination of HCP have higher vaccination rates. Future efforts to improve vaccination rates should include data on vaccine effectiveness and adverse effects, as well as descriptions of high-risk populations. |
Support for universal childhood vaccination against influenza among private pediatric clinics and public health departments in Georgia
Pazol K , Prill MM , Gazmararian JA , O'Malley EM , Jelks D , Coleman MS , Hinman AR , Orenstein WA . J Public Health Manag Pract 2009 15 (5) 393-400 Recently, it has been recommended that all persons 6 months to 18 years be vaccinated annually against influenza. To assess support for this universal recommendation leading up to its implementation, a cross-sectional survey of healthcare workers at private pediatric clinics (N = 44) and public health departments (N = 75) was conducted. The survey, conducted in the state of Georgia during 2005-2006, asked about (a) support for universal childhood vaccination against influenza, (b) general and influenza-specific immunization practices in 2004-2005, and (c) types of assistance needed to implement a universal childhood recommendation. Our response rate was 70 percent for private clinics and 71 percent for public health departments. The majority of providers supported universal childhood vaccination against influenza; agreement was especially pronounced at public health departments. Public health departments employed more nurses and were more likely to have a policy of vaccinating parents along with their children; private clinics were more likely to use patient reminders or add extra hours during the influenza vaccination season. Respondents from both types of clinics indicated they would need multiple forms of assistance to implement a universal recommendation for childhood vaccination against influenza. Given the strong support for universal vaccination among healthcare workers at public health departments, these facilities may be instrumental for reaching the large number of children recently added to the recommendations. However, these facilities will need multiple forms of assistance. |
The effect of counting principal and secondary injuries on national estimates of motor vehicle-related trauma: a NEISS-AIP special study
Halpin J , Greenspan AI , Haileyesus T , Annest JL . Inj Prev 2009 15 (5) 328-33 OBJECTIVE: To demonstrate the effect of including both principal and secondary injuries in the calculation of national estimates of non-fatal motor vehicle-related injury, using the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). METHODS: The setting was a stratified sample of 15 US hospital emergency departments selected among 50 NEISS-AIP hospitals which agreed to participate in the study. Non-fatal injury data from a special study of the 2004 NEISS-AIP were analysed which allowed up to five injuries to be coded per case. National estimates of number and rate of injuries for 2004 were calculated, first using principal injuries alone, then by including principal and secondary injuries. RESULTS: An estimated 4,833,626 principal and secondary injuries were sustained by the estimated 2,893,782 motor vehicle occupants involved in a crash and treated in US hospital emergency departments (EDs) in 2004. This represents a 67% increase in the total number of injuries compared with an estimate of principal injury alone. Incidence of contusions/abrasions and lower trunk injuries rose most steeply among broad injury types, and whiplash injury rose 18% in number and rate. A significantly lower percentage of cases with a single listed injury were hospitalised (5%) compared with those who sustained multiple injuries (8%). CONCLUSIONS: Based on an analysis of NEISS-AIP special study data, the inclusion of both principal and secondary injuries in national estimates of motor vehicle-related occupant injury would provide a more comprehensive report of non-fatal injuries treated in US hospital EDs. Other countries with ED-based surveillance systems could consider reporting multiple injuries when assessing injury count associated with motor vehicle trauma requiring ED care. |
National Academy of Clinical Biochemistry laboratory medicine practice guidelines: follow-up testing for metabolic disease identified by expanded newborn screening using tandem mass spectrometry; executive summary
Dietzen DJ , Rinaldo P , Whitley RJ , Rhead WJ , Hannon WH , Garg UC , Lo SF , Bennett MJ . Clin Chem 2009 55 (9) 1615-26 BACKGROUND: Almost all newborns in the US are screened at birth for multiple inborn errors of metabolism using tandem mass spectrometry. Screening tests are designed to be sufficiently sensitive so that cases are not missed. The NACB recognized a need for standard guidelines for laboratory confirmation of a positive newborn screen such that all babies would benefit from equal and optimal follow-up by confirmatory testing. METHODS: A committee was formed to review available data pertaining to confirmatory testing. The committee evaluated previously published guidelines, published methodological and clinical studies, clinical case reports, and expert opinion to support optimal confirmatory testing. Grading was based on guidelines adopted from criteria derived from the US Preventive Services Task Force and on the strength of recommendations and the quality of the evidence. Three primary methods of analyte measurement were evaluated for confirmatory testing including measurement of amino acids, organic acids, and carnitine esters. The committee graded the evidence for diagnostic utility of each test for the screened conditions. RESULTS: Ample data and experience were available to make strong recommendations for the practice of analyzing amino acids, organic acids, and acylcarnitines. Likewise, strong recommendations were made for the follow-up test menu for many disorders, particularly those with highest prevalence. Fewer data exist to determine the impact of newborn screening on patient outcomes in all but a few disorders. The guidelines also provide an assessment of developing technology that will fuel a refinement of current practice and ultimate expansion of the diseases detectable by tandem mass spectrometry. CONCLUSIONS: Guidelines are provided for optimal follow-up testing for positive newborn screens using tandem mass spectrometry. The committee regards these tests as reliable and currently optimal for follow-up testing. . |
Prospective comparison of tuberculin skin test and QuantiFERON-TB Gold In-Tube assay for the detection of latent tuberculosis infection among healthcare workers in a low-incidence setting
Cummings KJ , Smith TS , Shogren ES , Khakoo R , Nanda S , Bunner L , Smithmyer A , Soccorsi D , Kashon ML , Mazurek GH , Friedman LN , Weissman DN . Infect Control Hosp Epidemiol 2009 30 (11) 1123-6 We compared the results of the tuberculin skin test with the results of the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay among 182 low-risk healthcare workers. Overall agreement and specificity were high, but the tests did not agree on positive results. Only 2 of 5 positive QFT-GIT assay results could be confirmed with repeat analyses. Indeterminate results were associated with potential immunosuppression. |
Proteomic analysis of Rickettsia parkeri strain Portsmouth
Pornwiroon W , Bourchookarn A , Paddock CD , Macaluso KR . Infect Immun 2009 77 (12) 5262-71 Rickettsia parkeri, a recently recognized pathogen of human, is one of several Rickettsia spp. in the United States that causes a spotted fever rickettsiosis. To gain insights into its biology and pathogenesis, we applied the proteomics approach to establish a two-dimensional gel proteome reference map and combined this technique with cell surface biotinylation to identify surface-exposed proteins of a low-passage isolate of R. parkeri obtained from a patient. We identified 91 proteins by matrix-assisted laser desorption ionization tandem time of flight mass spectrometry. Of these, 28 were characterized as surface proteins including virulence-related proteins (e.g., outer membrane protein (Omp) A, OmpB, beta-peptide and RickA). Two-dimensional immunoblotting with serum from the R. parkeri-infected index patient was utilized to identify the immunoreactive proteins as potential targets for diagnosis and vaccine development. In addition to known rickettsial antigens, Omps A and B, we identified translation initiation factor IF-2, cell division protein FtsZ, and cysteinyl-tRNA synthetase as immunoreactive proteins. The proteome map with corresponding cell surface protein analysis and antigen detection will facilitate a better understanding of the mechanisms of rickettsial pathogenesis. |
A simple methodology to analyze inter-laboratory data: a simulation study
Jain RB . Clin Chim Acta 2009 410 79-84 BACKGROUND: Inter-laboratory experiments are conducted to assess how accurately and reproducibly various laboratories using different methods, instruments, analysts, and/or sample preparation procedures can perform measurements, in this case, the concentration of a chemical. In this work a 3-step methodology is proposed to analyze inter-laboratory experiments. METHODS: A simulation study based on 500 simulations was conducted for a cluster of 12 laboratories with different population means and SDs. The sample sizes varied from 10 to 50. Laboratories with too high a variance or too high a mean were recursively identified and removed by analysis of variance techniques. Outliers were identified and removed by a recursive algorithm. The remaining data were used to compute consensus mean, SD, repeatability, reproducibility, and CV for repeatability and reproducibility. RESULTS: Two laboratories with too high a variance were always identified for removal when the sample size was ≥20. Two laboratories with too high a mean were almost always identified irrespective of sample size. The average observed percent bias was never >+/-3.2% irrespective of the sample size. The average percent imprecision was also within +/-10.4% for all laboratories. The average CV was close to what was expected. CONCLUSIONS: With an optimal sample size of 20, the 3-step methodology presented here will adequately identify laboratories with variances or means that are too high or too low. |
Virus research--25th anniversary issue. Preface
Mahy B . Virus Res 2009 143 (2) 139 This Special Issue of Virus Research marks 25 years of publication of the journal. It was conceived in 1983 during discussions I had in Cambridge, England with Louis ter Meer of Elsevier Science. Originally I wanted the journal to be called Virus, but investigations revealed that there was already a little-known journal of the same name, and so we went with Virus Research. To add an international flavour to the journal, I asked my friend Richard Compans, then in Birmingham, Alabama, to join me, and our first issue was published 25 years ago in 1984. I moved to the CDC in Atlanta, Georgia in 1989, and a few years later Professor Compans also moved to Atlanta, to take a Chair at Emory University, and remained an Editor of the journal until 2002. | As the journal grew, we realized that there was a need for additional Editors to deal with an ever increasing number of manuscript submissions, so we invited several other distinguished virologists to join us, including David Bishop (1989–1998), Andrew Ball (1989–2001), Harald zur Hausen (1996–2001), Ulrich Desselberger (2001–2004), Yoshihiro Kawaoka (2002–2005), Stephen Lommel (2005–2007), Luis Enjuanes (2004–), Dennis O’Callaghan (2005–) and Bradley Hillman (2007–). |
Development of a test system to evaluate decontamination procedures for viral droplets on respirators
Vo E , Rengasamy S , Shaffer R . Appl Environ Microbiol 2009 75 (23) 7303-9 The aim of this study was to develop a test system to evaluate the effectiveness of decontamination procedures for respirators contaminated with viral droplets. MS2 coliphage was used as a surrogate for pathogenic viruses. A viral droplet testing system was constructed and the size distribution of viral droplets loaded directly onto the respirator was characterized using an aerodynamic particle sizer. The size distribution was in the range of 0.5-15 mum, with the majority of the droplets centered in the range of 0.74-3.5 mum. Results also showed that the droplet testing system generated similar droplet concentrations (particle counts) at different respirator locations. The test system was validated by studying the relative decontamination efficiencies of sodium hypochlorite (bleach) and ultraviolet (UV) irradiation against droplets containing MS2 virus on filtering facepiece respirators. It was hypothesized that the more potent decontamination treatments would result in a correspondingly larger decrease in the number of viable viruses recovered from the respirator. Sodium hypochlorite doses of 2.75-5.50 mg/L with a 10 min decontamination period resulted in approximately 3-4 log reductions of MS2 coliphage. By using higher sodium hypochlorite doses (≥ 8.25 mg/L) with the same contact time as used for the dilute solutions of 2.75-5.50 mg/L, all MS2 was inactivated. For the UV decontamination at 254 nm wavelength, approximately 3 log reduction of MS2 virus was achieved using 4.32 J/cm(2) dose (3 hours contact time with UV intensity of 0.4 mW/cm(2)) while with the higher UV irradiation dose (≥ 7.20 J/cm(2); UV intensity = 0.4 mW/cm(2) and contact times ≥ 5 hours), all MS2 was inactivated. These findings may lead to the development of a standard test method for respirator decontamination when challenged by viral droplets. |
Evaluation of three commercial broth media for pigment detection and identification of group B streptococci (GBS), Streptococcus agalactiae
Carvalho MD , Facklam R , Jackson D , Beall B , McGee L . J Clin Microbiol 2009 47 (12) 4161-3 Detection of GBS strains at various bacterial concentrations was evaluated using three pigment-producing broth media. At 10(3) CFU/ml, StrepB Carrot Broth(TM) (SBCB), Granada Instant Liquid Biphasic (IGLB), and Northeast Laboratory GBS Screening Medium (NEL-GBS) showed 100% detection but at the lower bacterial counts SBCB and IGLB were more sensitive than NEL-GBS after 24hrs. |
Field evaluation of crystal VC Rapid Dipstick test for cholera during a cholera outbreak in Guinea-Bissau
Harris JR , Cavallaro EC , de Nobrega AA , Dos SBarrado JC , Bopp C , Parsons MB , Djalo D , Fonseca FG , Ba U , Semedo A , Sobel J , Mintz ED . Trop Med Int Health 2009 14 (9) 1117-21 OBJECTIVES: To evaluate performance characteristics and ease of use of the new commercially available Crystal VC Rapid Dipstick (VC) test (Span Diagnostics, India) for Vibrio cholerae O1 and O139. METHODS: Whole stool was collected from patients presenting to a hospital cholera ward during a 2008 epidemic in Guinea-Bissau. The VC test on stool samples was conducted on-site; samples were subsequently stored in Cary-Blair transport media and sent to the Centers for Disease Control and Prevention for diagnostic testing by culture and polymerase chain reaction (PCR). In addition, four local laboratory technicians who were unfamiliar with the test were provided with stool samples, the VC test kit, and simple written instructions and asked to perform the test and interpret results. RESULTS: A total of 101 stool specimens were collected and tested. Compared with PCR, the test was 97% sensitive and 71-76% specific. Laboratory technicians in Bissau performed the test and interpreted results correctly using only simple written instructions. CONCLUSIONS: The VC test may be useful for cholera diagnosis in outbreak situations where laboratory capacity is limited. |
The impact of clinical laboratory improvement advisory committee recommendations on microbiology laboratories
Anderson NL , Bosse DC , Weissfeld AS . Clin Microbiol Newsl 2009 31 (17) 129-136 The Clinical Laboratory Improvement Advisory Committee (CLIAC) was mandated by the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and established in 1992 to provide advice to the Department of Health and Human Services on regulation of laboratory testing and improving laboratory quality. Since then, CLIAC has met regularly and recommended regulatory changes to CLIA, provided input on good laboratory practices, and discussed critical issues related to clinical and public health testing, the laboratory workforce, and laboratory systems research. The Committee has been effective in driving changes to microbiology quality control, which have led to a decreased burden and lower laboratory costs without sacrificing quality. The issues CLIAC addresses are complex and sometimes controversial, yet members have said their time on the Committee is worthwhile and that CLIAC has a positive influence on laboratory medicine. This Committee will remain a vital resource for providing guidance as laboratory testing continues to evolve. copyright 2009 Elsevier Inc. All rights reserved. |
Maternal body mass index and daughters' age at menarche
Keim SA , Branum AM , Klebanoff MA , Zemel BS . Epidemiology 2009 20 (5) 677-81 BACKGROUND: The role of intergenerational influences on age at menarche has not been explored far beyond the association between mothers' and daughters' menarcheal ages. Small size at birth and childhood obesity have been associated with younger age at menarche, but the influence of maternal overweight or obesity on daughters' age at menarche has not been thoroughly examined. METHODS: In a follow-up study of the prospective Collaborative Perinatal Project, grown daughters were asked in 1987-1991 for their age at menarche. Data from the original Collaborative Perinatal Project (1959-1966) included their mothers' height and prepregnancy weight. In the follow-up study, 597 of 627 daughters had complete menarche and maternal data available and were included in the present analysis. We used polytomous logistic regression to examine the association between maternal overweight (body mass index [BMI] = 25-29.9 km/m) or obesity (BMI >or= 30) and daughter's age at menarche (<or=12, 12, 13, 14+ years). RESULTS: Compared with those whose mothers had a BMI less than 25, daughters of obese mothers experienced younger age at menarche (OR for menarche at <or=12 years = 3.1 [1.1-9.2]). This association remained after adjusting for maternal age at menarche, maternal parity, socioeconomic status, race, and study site (OR = 3.3 [1.1-10.0]). Effect estimates for maternal overweight were close to the null. There was limited evidence of mediation by small for gestational age or BMI at age 7. CONCLUSIONS: Maternal obesity is associated with younger menarcheal age among daughters in this study, possibly via unmeasured shared factors. |
Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007
Kogan MD , Blumberg SJ , Schieve LA , Boyle CA , Perrin JM , Ghandour RM , Singh GK , Strickland BB , Trevathan E , van Dyck PC . Pediatrics 2009 124 (5) 1395-403 OBJECTIVES: The reported increasing prevalence of autism spectrum disorder (ASD) and attendant health and family impact make monitoring of ASD prevalence a public health priority. METHODS: The prevalence of parent-reported diagnosis of ASD among US children aged 3 to 17 years was estimated from the 2007 National Survey of Children's Health (sample size: 78037). A child was considered to have ASD if a parent/guardian reported that a doctor or other health care provider had ever said that the child had ASD and that the child currently had the condition. The point-prevalence for ASD was calculated for those children meeting both criteria. We examined sociodemographic factors associated with current ASD and with a past (but not current) ASD diagnosis. The health care experiences for children in both ASD groups were explored. RESULTS: The weighted current ASD point-prevalence was 110 per 10,000. We estimate that 673,000 US children have ASD. Odds of having ASD were 4 times as large for boys than girls. Non-Hispanic (NH) black and multiracial children had lower odds of ASD than NH white children. Nearly 40% of those ever diagnosed with ASD did not currently have the condition; NH black children were more likely than NH white children to not have current ASD. Children in both ASD groups were less likely than children without ASD to receive care within a medical home. CONCLUSIONS: The observed point-prevalence is higher than previous US estimates. More inclusive survey questions, increased population awareness, and improved screening and identification by providers may partly explain this finding. |
Association between prepregnancy body mass index and congenital heart defects
Gilboa SM , Correa A , Botto LD , Rasmussen SA , Waller DK , Hobbs CA , Cleves MA , Riehle-Colarusso TJ , National Birth Defects Prevention Study . Am J Obstet Gynecol 2009 202 (1) 51.e1-51.e10 OBJECTIVE: The purpose of this study was to examine associations between prepregnancy body mass index (BMI) and congenital heart defects (CHDs). STUDY DESIGN: These analyses included case infants with CHDs (n = 6440) and liveborn control infants without birth defects (n = 5673) enrolled in the National Birth Defects Prevention Study (1997-2004). RESULTS: Adjusted odds ratios for all CHDs combined were 1.16 (95% confidence interval [CI], 1.05-1.29), 1.15 (95% CI, 1.00-1.32), and 1.31 (95% CI, 1.11-1.56) for overweight status, moderate obesity, and severe obesity, respectively. Phenotypes associated with elevated BMI (≥25.0 kg/m(2)) were conotruncal defects (tetralogy of Fallot), total anomalous pulmonary venous return, hypoplastic left heart syndrome, right ventricular outflow tract (RVOT) defects (pulmonary valve stenosis), and septal defects (secundum atrial septal defect). CONCLUSION: These results corroborated those of previous studies and suggested new associations between obesity and conotruncal defects and RVOT defects. |
Congenital cytomegalovirus (CMV) epidemiology and awareness
Cannon MJ . J Clin Virol 2009 46 S6-10 This commentary highlights and discusses the implications of a number of recent studies that refine epidemiologic knowledge of CMV infection and assess awareness of congenital CMV among clinicians and the public. These studies highlight that: (1) congenital CMV results in a disease burden that is substantial and severe; (2) a high proportion of United States women of reproductive age are susceptible to CMV infection; (3) the majority of congenital CMV infections in the United States result from recurrent infections among pregnant women; (4) CMV seroprevalence and seroincidence are much higher among racial/ethnic minorities and persons of lower socioeconomic status (SES); (5) household transmission of CMV appears to be an important transmission route in the United States; (6) sexual transmission of CMV appears to be an important transmission route in some population sub-groups in the United States; (7) women have limited awareness and knowledge about congenital CMV; (8) most obstetrician/gynecologists do not counsel women about prevention of congenital CMV; (9) most women view CMV prevention messages positively. |
Hospitalization and mortality among primarily non-breastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006
Creek TL , Kim A , Lu L , Bowen A , Masunge J , Arvelo W , Smit M , Mach O , Legwaila K , Motswere C , Zaks L , Finkbeiner T , Povinelli L , Maruping M , Ngwaru G , Tebele G , Bopp C , Puhr N , Johnston SP , Dasilva AJ , Bern C , Beard RS , Davis MK . J Acquir Immune Defic Syndr 2009 53 (1) 14-9 BACKGROUND: In 2006, a pediatric diarrhea outbreak occurred in Botswana, coinciding with heavy rains. Surveillance recorded a 3 times increase in cases and a 25 fold increase in deaths between January and March. Botswana has high HIV prevalence among pregnant women (33.4% in 2005), and an estimated 35% of all infants under the age of 6 months are not breastfed. METHODS: We followed all children <5 years old with diarrhea in the country's second largest referral hospital at the peak of the outbreak by chart review, interviewed mothers, and conducted laboratory testing for HIV and enteric pathogens. RESULTS: Of 153 hospitalized children with diarrhea, 97% were <2 years old; 88% of these were not breastfeeding. HIV was diagnosed in 18% of children and 64% of mothers. Cryptosporidium and enteropathogenic Escherichia coli were common; many children had multiple pathogens. Severe acute malnutrition (kwashiorkor or marasmus) developed in 38 (25%) patients, and 33 (22%) died. Kwashiorkor increased risk for death (relative risk 2.0; P = 0.05); only one breastfeeding child died. Many children who died had been undersupplied with formula. CONCLUSIONS: Most of the severe morbidity and mortality in this outbreak occurred in children who were HIV negative and not breastfed. Feeding and nutritional factors were the most important determinants of severe illness and death. Breastfeeding is critical to infant survival in the developing world, and support for breastfeeding among HIV-negative women, and HIV-positive women who cannot formula feed safely, may prevent further high-mortality outbreaks. |
Distributing free fresh fruit and vegetables at school: results of a pilot outcome evaluation
Coyle KK , Potter S , Schneider D , May G , Robin LE , Seymour J , Debrot K . Public Health Rep 2009 124 (5) 660-9 OBJECTIVES: Consumption of fruit and vegetables among children is generally below recommended levels. This evaluation addressed two questions: (1) To what extent did children's attitudes toward, familiarity with, and preferences for fruit and vegetables change during the school year? and (2) To what extent did children's consumption of fruit and vegetables change during the school year? METHODS: During the 2004-2005 school year, the Mississippi Department of Education, Child Nutrition Programs initiated a pilot program to distribute free fruit and vegetables to students (kindergarten through 12th grade) during the school day. Data were collected in 2004-2005 within a one-group pretest/posttest design using a self-report questionnaire (n=725) and 24-hour dietary recalls (n=207) with a sample of students from five schools in Mississippi. Data were analyzed in 2006-2007. RESULTS: Results showed greater familiarity with fruit and vegetables at all grade levels (p<0.05) and increased preferences for fruit among eighth- and 10th-grade students (p<0.01). Eighth-grade students also reported more positive attitudes toward eating fruit and vegetables (p<0.01), increased perceived self-efficacy to eat more fruit (p<0.01), and increased willingness to try new fruit. Finally, results showed increased consumption of fruit, but not vegetables, among eighth- and 10th-grade students (p<0.001). CONCLUSIONS: Distributing free fruit and vegetables at school may be a viable component of a more comprehensive approach for improving students' nutrition attitudes and behaviors. More program emphasis is needed on ways to promote vegetable consumption. |
Occupational health crossing borders - part 1: concept, teaching methods, and user evaluation of the first international summer school in Munich, Germany
Radon K , Ehrenstein V , Bigaignon-Cantineau J , Vellore AD , Fingerhut M , Nowak D , Occupational Health Crossing Borders Summer School . Am J Ind Med 2009 52 (10) 774-81 BACKGROUND: Occupational health and safety (OHS) is relevant for occupational health professionals (OHP) throughout the world. However, training opportunities are often limited and exchange between OHP from industrialized and developing countries is sparse. We aimed to contribute to the international exchange of OHP through a 2-week summer school program. METHODS: Twenty-three OHP from 11 countries participated. Teaching methods included interactive lectures, participants' presentations, case-based e-learning, enterprise visits, and hands-on sessions. After completion, participants evaluated the course. RESULTS: OHS systems of 18 different countries were presented using the same set of clinical cases as a starting point. Opportunities and challenges in the different OHS systems were considered. On median, participants rated the course as excellent and totally agreed that it will help them in their daily work. CONCLUSIONS: An international summer school teaching basic aspects of different OHS systems is a useful tool for training and exchange at the global level. |
Pandemic influenza and farmworkers: the effects of employment, social, and economic factors
Steege AL , Baron S , Davis S , Torres-Kilgore J , Sweeney MH . Am J Public Health 2009 99 S308-15 Employment, social, and economic factors have the potential to affect the magnitude of an influenza pandemic among farmworkers. Prevention efforts targeted toward livestock farmworkers, including increased access to seasonal influenza vaccine, risk reduction training, various forms of personal protection, and workplace sanitation, are needed. Crop and livestock farmworkers are at increased risk of exposure to influenza A viruses because of limited resources, substandard housing, immigration status, communication and cultural barriers, and discrimination. Recommendations were gathered from migrant clinicians, farmworker advocates, state and federal government agencies, industry stakeholders, and researchers to overcome these barriers, including surveillance of livestock farmworkers, inclusion of farmworker service organizations in planning efforts, and separation of immigration enforcement from emergency assistance. |
Protecting home health care workers: a challenge to pandemic influenza preparedness planning
Baron S , McPhaul K , Phillips S , Gershon R , Lipscomb J . Am J Public Health 2009 99 S301-7 The home health care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities. Home health care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help home health care workers protect their income and access to health care. We summarize findings from a national stakeholder meeting, which highlighted the need to integrate home health care employers, workers, community advocates, and labor unions into the planning process. |
Evaluation of five decontamination methods for filtering facepiece respirators
Viscusi DJ , Bergman MS , Eimer BC , Shaffer RE . Ann Occup Hyg 2009 53 (8) 815-27 Concerns have been raised regarding the availability of National Institute for Occupational Safety and Health (NIOSH)-certified N95 filtering facepiece respirators (FFRs) during an influenza pandemic. One possible strategy to mitigate a respirator shortage is to reuse FFRs following a biological decontamination process to render infectious material on the FFR inactive. However, little data exist on the effects of decontamination methods on respirator integrity and performance. This study evaluated five decontamination methods [ultraviolet germicidal irradiation (UVGI), ethylene oxide, vaporized hydrogen peroxide (VHP), microwave oven irradiation, and bleach] using nine models of NIOSH-certified respirators (three models each of N95 FFRs, surgical N95 respirators, and P100 FFRs) to determine which methods should be considered for future research studies. Following treatment by each decontamination method, the FFRs were evaluated for changes in physical appearance, odor, and laboratory performance (filter aerosol penetration and filter airflow resistance). Additional experiments (dry heat laboratory oven exposures, off-gassing, and FFR hydrophobicity) were subsequently conducted to better understand material properties and possible health risks to the respirator user following decontamination. However, this study did not assess the efficiency of the decontamination methods to inactivate viable microorganisms. Microwave oven irradiation melted samples from two FFR models. The remainder of the FFR samples that had been decontaminated had expected levels of filter aerosol penetration and filter airflow resistance. The scent of bleach remained noticeable following overnight drying and low levels of chlorine gas were found to off-gas from bleach-decontaminated FFRs when rehydrated with deionized water. UVGI, ethylene oxide (EtO), and VHP were found to be the most promising decontamination methods; however, concerns remain about the throughput capabilities for EtO and VHP. Further research is needed before any specific decontamination methods can be recommended. |
Technological aspects of solid-state and incandescent sources for miner cap lamps
Sammarco JJ , Freyssinier JP , Bullough JD , Zhang X , Reyes MA . IEEE Trans Ind Appl 2009 45 (5) 1583-1588 Light-emitting diodes (LEDs) are emerging as viable replacements for incandescent (INC)-based cap lamps used in mining. The photometric and energy characteristics of these light sources differ in important ways. This paper describes the performance of LED and INC sources in cap lamps in terms of correlated color temperature, color rendering, light output, electric power, ambient temperature and air flow, and light source aging. Importantly, these characteristics can influence a miner's ability to spot mining hazards thus impacting safety. Second, some of these characteristics interact with the operating life of the cap lamp's battery power, such that differences between LED and INC sources can be magnified toward the end of a 10-h battery discharge cycle. Empirically, we have determined that after 8 h at an ambient temperature of 25 degrees C, the average light output of an INC cap lamp can decrease to about 69% of its initial value when powered by a lead-acid battery, and it can decrease to about 65% of its initial value when powered by a nickel-hydride battery. An LED-based cap lamp using a constant current drive circuit can maintain about 96% of its initial value when powered by a nickel-hydride battery. Real-world tests addressing the effects of ambient temperature and air flow on the light output of an LED and INC cap lamp were conducted in the National Institute for Occupational Safety and Health Safety Research Coal Mine. The LED cap lamp yielded a vertical average illuminance improvement of approximately 9.5%, and the INC cap lamp yielded a vertical average illuminance degradation of approximately 4%. The differences between LED and INC cap lamps were further quantified by the calculation of "mesopic luminance" data that indicated for the same photopic luminance (i.e., as measured using a conventional light meter) the LED cap lamp could be up to 38% more efficient than the INC cap lamp with a lead-acid battery at the end of the 10-h driving cycle. Lastly, accelerated life tests were used to empirically determine light output depreciation as the INC light source age approached its useful life. There was about a 35% decrease in light output. This is quite considerable, particularly given that the light output will decrease an additional 30% to 45% over the period of a 10-h shift. The implications of the differences between LED and INC sources are discussed. This information is crucial in determining how visual performance could be affected for real-world conditions where batteries discharge during the work shift and as the light source ages. To date, only idealized conditions have been used for LED and INC cap lamp visual performance research. |
Analysis of applied forces and electromyography of back and shoulders muscles when performing a simulated hand scaling task
Porter W , Gallagher S , Torma-Krajewski J . Appl Ergon 2009 41 (3) 411-6 Hand scaling is a physically demanding task responsible for numerous overexertion injuries in underground mining. Scaling requires the miner to use a long pry bar to remove loose rock, reducing the likelihood of rock fall injuries. The experiments described in this article simulated "rib" scaling (scaling a mine wall) from an elevated bucket to examine force generation and electromyographic responses using two types of scaling bars (steel and fiberglass-reinforced aluminum) at five target heights ranging from floor level to 176cm. Ten male and six female subjects were tested in separate experiments. Peak and average force applied at the scaling bar tip and normalized electromyography (EMG) of the left and right pairs of the deltoid and erectores spinae muscles were obtained. Work height significantly affected peak prying force during scaling activities with highest force capacity at the lower levels. Bar type did not affect force generation. However, use of the lighter fiberglass bar required significantly more muscle activity to achieve the same force. Results of these studies suggest that miners scale points on the rock face that are below their knees, and reposition the bucket as often as necessary to do so. |
External L5-S1 joint moments when lifting wire mesh screen used to prevent rock falls in underground mines
Gallagher S , Kotowski S , Davis KG , Mark C , Compton CS , Huston RL , Connelly J . Int J Ind Ergon 2009 39 (5) 828-834 Bolting large sheets of wire mesh screen (WMS) to the roof of underground mines prevents injuries due to rock falls. However, WMS can be heavy and awkward to lift and transport, and may result in significant spinal loading. Accordingly, six male subjects (mean age = 45.8 years + 7.5 SD) were recruited to lift WMS in a laboratory investigation of the biomechanical demands. Biomechanical modeling was used to estimate external moments about L5-S1 for sixteen lifting tasks, using two sizes of WMS. Full-size WMS involved a two-person lift, while half-size WMS involved a one-person lift. Lifts were performed under 168 cm and 213 cm vertical space. Restriction in vertical space increased the maximum L5-S1 extensor moment from 254 to 274 Nm and right lateral bending moment from 195 to 251 Nm. Lifting full sheets of screen (as opposed to half sheets) resulted in an average 33 Nm increase in L5-S1 extensor moment. The L5-S1 extensor moment was increased by an average of 44 Nm (18%) when lifting screens positioned flat on the floor compared to an upright position. Relevance to industry: Large flexible materials are commonly lifted in industrial work environments, and may involve the efforts of two or more workers. The current study examines the low back loading associated with lifting large flexible screens and presents recommendations to reduce spine loading. Published by Elsevier B.V. |
Accountability: the fast lane on the highway to change
Beitsch LM , Corso LC . Am J Public Health 2009 99 (9) 1545 Today, more than ever, health departments are seeking funding in a hostile environment, in which other institutions such as schools and jails have already received the imprimatur of approval from accreditation. The public's demands for greater accountability, a nationwide call to action for a smarter and more effective health system, and an economic crisis that requires strategic investments have all been growing as the importance of public health has been reinforced by the emergence of the H1N1 virus. In these uncertain economic times, accountability via accreditation may confer a substantial competitive advantage in the governmental marketplace and set us on the road to fostering an improved health system. | Building on earlier initiatives, the Public Health Accreditation Board (PHAB) was formed in May 2007 with the goal of improving and protecting the health of every community by advancing the quality and performance of local, state, and tribal health departments through a voluntary national accreditation program. Via an open and deliberate process, PHAB is collaborating with national partners and the public health community to create and launch a voluntary national accreditation program in 2011. |
Estimates of body composition with dual-energy X-ray absorptiometry in adults
Li C , Ford ES , Zhao G , Balluz LS , Giles WH . Am J Clin Nutr 2009 90 (6) 1457-65 BACKGROUND: Little is known about the distributions of percentage body fat (PBF), total body fat (TBF), and fat-free mass (FFM) in the adult population in the United States. OBJECTIVES: We sought to estimate the means and percentile cutoffs of PBF, TBF, and FFM and to assess the differences by sex, age, race-ethnicity, and body mass index in US adults. DESIGN: Data from the National Health and Nutrition Examination Survey, which were collected during the 6-y period from 1999 to 2004 and comprise a large nationally representative sample of the US population, were analyzed (n = 6559 men and 6507 nonpregnant women). TBF and FFM were measured by using dual-energy X-ray absorptiometry. PBF was calculated as TBF divided by total mass multiplied by 100. RESULTS: There were large differences between men and women in unadjusted mean PBF (28.1% compared with 40.0%, P < 0.001), TBF (25.4 compared with 30.8 kg, P < 0.001), and FFM (62.3 compared with 44.0 kg, P < 0.001); the sex differences persisted across all body mass index categories after adjustment for age and race-ethnicity (all P < 0.001). The common percentile cutoffs of PBF, TBF, and FFM were estimated by sex, race-ethnicity, and age groups. Equations for the estimation of PBF (R(2) = 0.85), TBF (R(2) = 0.94), and FFM (R(2) = 0.94) according to demographic characteristics and simple anthropometric measures were generated. CONCLUSION: The estimates of means and percentile cutoffs for PBF, TBF, and FFM, on the basis of National Health and Nutrition Examination Survey 1999-2004 dual-energy X-ray absorptiometry data, provide a reference in the US adult population. |
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